Breast reconstruction in older women

More than 50% of breast cancer care in the United States occurs in women over age 65 years. This study investigates age-related differences in breast reconstruction practices after mastectomy for breast cancer.

Retrospective review of University of Michigan Breast Care Center patients revealed 242 female patients with breast cancer who underwent postmastectomy breast reconstruction from 1980 through 1991. Data were complied concerning patient age, reconstruction interval (immediate or delayed), type of breast reconstruction performed, reconstruction-associated complications, and the number of postreconstruction procedures required to obtain the final result. Statistical comparisons were made with the chi-squared test.

There were 224 patients aged less than 60 years (range 27 to 59 years; median, 44 years) and 18 patients aged 60 years or more (oldest, 68 years). Of the 18 older patients, three underwent delayed transverse rectus abdominus muscle (TRAM) reconstruction; one received a delayed latissimus dorsi flap placed over a silicone gel prosthesis, and 14 underwent 18 reconstructions (4 bilateral) with silicone gel implants (6 immediate, 12 delayed). The younger patients underwent 269 breast reconstructions (45 bilateral), including 92 autogenous tissue reconstructions (34 immediate TRAM, 58 delayed TRAM), 60 immediate and 88 delayed insertions of an expander or prosthesis, and 29 latissimus dorsi flaps with implant reconstructions (3 immediate, 26 delayed). Seven complications (32%) occurred in the 22 breast reconstructions performed in older women, including capsular contracture surrounding an implant (six patients) and a ventral hernia in one patient with a TRAM flap. Complications occurred in 134 breast reconstructions (50%) performed in younger women. All were related to the reconstruction. In the older women a mean of 1.7 +/- 0.7 operations was required to achieve a final reconstruction result versus 2.1 +/- 1.1 in the younger women (not significant). More operations were required in younger women undergoing prosthetic reconstruction than in older women, but this difference was not statistically significant (2.4 +/- 1.2 versus 1.9 +/- 0.7; p = 0.07). Autogenous tissue reconstruction was performed less frequently in older women (14% versus 34%; p < 0.05). No age-related difference was noted in the rate of immediate (versus delayed) reconstruction (27% versus 36%, respectively). Complications occurred more frequently in women who underwent prosthetic breast reconstruction, particularly in younger women (32% in older women and 64% in younger women; p < 0.01). The complication rate for immediate breast reconstruction in older women (all prosthetic) was less than in younger women (17% versus 59%; p < 0.05). For delayed prosthetic reconstructions, complications also occurred less frequently in older than younger women (38% versus 67%; p < 0.05). Between 1988 and 1992, 91 older women and 180 younger women underwent mastectomy for breast cancer; only 7% of older women versus 38% of younger women underwent breast reconstruction (p < 0.001).

Breast reconstruction is a safe option for older women requiring mastectomy. The full array of reconstruction options (autogenous tissue or implants, immediate or delayed) should be considered for use in women of all ages.